PB2577: INFECTIONS AND THEIR RELATIONSHIP WITH EARLY MORTALITY IN PATIENTS NEWLY DIAGNOSED WITH MULTIPLE MYELOMA
Authors: Juan Luis Ontiveros-Austria, Sergio Rodriguez-Rodriguez, Sandra Rajme López, Alfonso Orozco Collazo, Santiago Riviello Goya, Aldo Alejandro Silva Esparza, Sofía Ávila Luna, Alec Seidman Sorsby, Deborah Martínez Baños
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Early mortality associated with infections in patients with newly diagnosed multiple myeloma (NDMM) is as high as 22% in the first 180 days after diagnosis; over 50% of this mortality is related to infectious episodes. Infections are more frequent during the first three months after the diagnosis and at the beginning of the treatment. In Latin America, information about risk factors and epidemiology of infections is scarce, reporting a prevalence of 35.9% among the patient’s evolution and 67.3% over the first three months of diagnosis. Aims: To describe the characteristics of infectious episodes in patients with NDMM, their early mortality, and their associated risk factors. Methods: We retrospectively analyzed a cohort of patients with NDMM between January 2017 and December 2020. Baseline characteristics were described with mean and standard deviation, or median and interquartile ranges, as appropriate. Group comparisons were calculated using χ2, Fisher exact test, Student’s T, and log-rank. The multivariate analysis was performed via binary logistic regression. Results: One hundred nineteen patients were evaluated. Sixty-six patients (55.5%) were women. The median age was 62 years (range 31-87 years). Median follow-up was 32 months (0 – 146 months), and baseline characteristics were similar between groups. During the entire follow-up, 83 patients developed at least one infectious episode, 37 (44.6%) during the first four months after diagnosis, and 18 (15%) presented more than one episode. Infection distribution was as follows: pneumonia 36%, genitourinary 29.3%, upper respiratory tract, and gastrointestinal tract 9.3% each, soft tissues 8%, bacteriemia 6.8%, and unidentified source 1.3%. The infection etiology is graphed in figure 1. Among the risk factors associated with a higher rate of infections during the first three months, it stands out lower serum IgA (337.1 vs. 593.7mg/dL, p=0.010), and among the 102 patients who had immunoglobulins determined, immunoparesis (88.2% vs. 67.6% OR=3.58 (95% CI 1.12-11.45), p=0.030). Also, a tendency towards increasing early mortality during the first four months after the diagnosis was evident (12.2% vs. 2.6% OR=5.278 (95% CI 0.977-28.5) p=0.047). In the univariate analysis, factors associated with an increased risk of early infection were lactic dehydrogenase (LDH) higher than the standard upper limit of 271 U/mL (OR=2.554 (95% CI 1.038-6.284), p=0.041), IgA under 66 mg/dL (OR=2.316 (95% CI 1.068-5.019), p=0.033) and immunoparesis (OR=3.587 (95% CI 1.124-11.447) p=0.031), despite these findings, in the multivariate analysis they were not held. Summary/Conclusion: In our cohort, more than half of the patients presented at least one infectious episode, and almost half presented it during the first four months after the diagnosis; one-third had pneumonia as the first infection. E. coli remains the leading cause of infection, but an etiology was not identified in one-fourth of the patients. Immunoparesis, a lower IgA concentration, and a higher LDH were significantly associated with an infection on univariate analysis. Nonetheless, such association was not maintained in the multivariate analysis. Early mortality in NDMM is strongly related to the appearance of infections during the first months, and immunoparesis and high LDH levels are risk factors for presenting them. Rapid detection of patients at risk is imperative to establish stricter surveillance.Keywords: Mortality, Infection, Multiple myeloma, Risk factor